Overview

Your body will undergo a more significant transformation during pregnancy than in any other period. Although building and growing a human is an amazing feat, not everyone is thrilled about the physical changes. There is evidence that women commonly experience body dissatisfaction during and after pregnancy. This can range from having negative thoughts to struggling with body dysmorphia or an eating disorder. Many external factors influence your thoughts, feelings, and perception of your body. The body image you internalize plays a significant role in your mental health. This article focuses on the forces that influence body image and how you can reframe how you view your body during pregnancy and after you have your baby.

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Body Image 

Body image is your thoughts, feelings, and perception of your body. This is entirely subjective, and what you see in the mirror may be completely different from what others see. The term “body image” was coined in 1935 by a neurologist and psychoanalyst who wrote about how a person’s body perception may not correspond to society’s standards. Body image lies on a vast spectrum, from the positive end of feeling confident about how you look to body dysmorphic disorder. 

Our ideas about body image are shaped by what we see daily, advertising, social media, and the people surrounding us. It is influenced by how people perceive us and what we hear about our bodies and appearance. These effects can start very young and persist throughout our lives.

Advertising and Celebrities

Advertising contributes to so many images we see portraying ideal body images. This is changing as more companies embrace different figures and utilize models with varying appearances and body types. While advertising may be trending in the right direction, media inundates us with perfect images that are heavily edited to alter everything from wrinkles to skin tone to weight.

These models have been through hair, makeup, and professional stylists before stepping in front of the camera. For a model, looking good in front of a camera is their job, and they work to be good at it. You do not see the hours in the gym, the personal trainers, the meal prep, the dieting, or worse, the eating disorders. You don’t see the Botox or the surgeries if they have had work done. A professional photographer holds the camera. Their job is to take excellent photos and edit them in post-production before printing. You only see the finished product. This all results in unattainable beauty standards. Even when we know this, it can still influence how we perceive our body image.

One study asked pregnant or postpartum mothers to view either a mock-up of a celebrity magazine featuring photos of pregnant celebrities or a home décor magazine. They found the pregnant participants reported significantly worse body image after viewing the celebrity magazine than those reading the control magazine.

Social Media 

Social media has become a significant influence. What you see on someone’s Instagram feed is what they want you to see. It is often the polished version of reality. Anyone with a smartphone can easily add filters or touch up pictures. The biggest problem with social media is that we constantly compare ourselves to others. Some of those perfectly polished pics you see in your feed are not just professional models; they are your friends. They are people you relate to and respect, which can make it even more tempting to compare your life or your body to theirs.

One study looked at the effects of viewing fitspiration on Instagram. This online trend inspires viewers towards a healthier lifestyle by promoting exercise and healthy food. They did find that these posts have a positive effect on motivation to pursue these goals. Unfortunately, these posts had a negative impact on body image. If you feel negative about yourself after scrolling on social media, you may want to rethink the accounts you follow. You may also consider limiting your time on social media.

Friends and Family 

Another significant influence on our idea of body image is the people closest to us. This includes the behavior modeled by your parents, comments made by family, opinions of your friends, your significant other, and even your co-workers. Sometimes, even just a little comment can have a substantial impact.

Influence from those close to us is something for you to keep in mind as you raise another human. We have to be mindful of what we are telling our children. Perhaps even more importantly, we must be conscious about what we model for our children with our actions. You can emphasize daily that being healthy and confident about your body is essential. If your child sees you obsessing over your weight, stressing out about what you eat, complaining about your own body, or making negative comments about other people’s bodies, those messages will be received and ingrained in their minds. 

Confidence 

Perhaps the most significant thing we think about when considering how you are affected by your body image is confidence. We overlook how much our confidence can impact our lives. Your confidence affects how you project yourself. Think about the difference between confidently walking into a room or walking into a room not feeling good about how you look, whether people are judging you, and not feeling good about yourself. Body image can also affect your sex life and intimacy. Think about how much you tie your self-worth to how you look. Your body image affects many more aspects of your life outside of just time spent in front of a mirror. 

You can expect changes in your body image during any phase of your life where your body goes through a physical transformation. These can be positive or negative. Think back to when you hit puberty. You started getting breasts. You started growing hair in places you didn’t have it before. How did those changes affect your body image? Maybe you knew what to expect, and perhaps it was a surprise. You could have been excited or even unhappy with those changes.

Now, more recently, think back to before you were pregnant to the ideas about your body changing during pregnancy. I can share my thoughts, which I was terrified about all of it. I was afraid of gaining weight, my breasts getting bigger, getting stretch marks, and having a baby take over my body. I did not know what to expect, and it all freaked me out. 

Body Changes During Pregnancy 

There is evidence that women experience body dissatisfaction during and after pregnancy. You should have a heads-up on the changes that can happen to your body during pregnancy so nothing surprises you. You know you gaining weight is inevitable. Your breasts will increase in size and go through many other changes in appearance. You may get stretch marks. You can have other temporary changes in your skin pigmentation, like a dark stripe down the center of your belly called the linea nigra. Hormones in pregnancy and after you have your baby can change your hair. During pregnancy, you may have thicker, fuller hair. The downside is that you shed all of that extra hair postpartum.

After you have your baby, your body takes time to heal and recover from birth. It will take time and effort to lose the additional weight you put on. It will take time for your breasts to reduce in size. There are also positive changes, like learning how strong and capable your body is. You’re going to get strong arms carrying around a baby. As your baby grows and starts crawling, walking, and running, chasing after them is an excellent workout. This is the abbreviated version of many changes. Everyone is unique, and your experience may differ from someone else. 

Common Themes with Body Image and Pregnancy

A meta-analysis that included 17 papers looked at how pregnancy-related physical changes can significantly impact a woman’s body image, and they found three main themes. Each theme highlights some inner struggles you may experience as you navigate this.

The first was fatness vs. pregnancy. Women know that gaining weight is part of pregnancy and, in a sense, are protected from judgment around that because they are pregnant. Changes like bigger breasts would move toward a social ideal, but stretch marks would move away. The second theme was control, and the researchers called this nature vs. self. This describes nature as the driving force behind the changes in your body during pregnancy and the desire to control the changes. Some women felt a loss of control over their bodies during pregnancy. The third theme in this meta-analysis was the role of woman vs. mother. Many saw this as an either-or as if the two identities conflicted.

Weight Gain 

Once you are pregnant, there is a lot of focus on weight gain because it is standard practice for OBGYNs and midwives to weigh you at every appointment. Keep in mind your care provider is doing this to track your weight gain to monitor your health and the health of your pregnancy, but that does not mean you will love stepping on the scale every time. When you are pregnant, the weight you gain isn’t all just weight in your belly. 

• Your breasts grow 1 to 3 pounds (about 0.5 to 1.4 kilograms) 
• Your larger uterus adds 2 pounds (about 0.9 kilograms) 
• Your placenta at birth is about 1.5 pounds (about 0.7 kilograms) 
• You gain 2 pounds (about 0.9 kilograms) in amniotic fluid 
• Your increased blood volume adds 3 to 4 pounds (about 1.4 to 1.8 kilograms) 
• Your increased fluid volume contributes to another 2 to 3 pounds (about 0.9 to 1.4 kilograms) 
• Finally, your fat stores add about 6 to 8 pounds (about 2.7 to 3.6 kilograms). 
• Don’t forget about your baby, which weighs around 7 or 8 pounds (about 3 to 3.6 kilograms). 

These amounts are all estimates and averages, and every woman is different, but this should give you some guidelines about where all that weight you will put on comes from. All of this growth, and the weight gain that comes from it, is necessary for you to have a healthy baby. See this article for more in-depth information on gaining weight during pregnancy. 

Comments on Your Body

It isn’t just your doctor or midwife commenting on your weight. Other people, or even strangers, may comment on your weight or growing belly. I am sending you all the positive thoughts that any comments you receive are positive. Although most people are well-meaning, it doesn’t always come off that way. You hear about the expecting mom who gets the comment, “Oh, you must be having twins,” when she is not. Even a comment about your belly being small can negatively affect someone self-conscious about their size.

Unfortunately, you can’t control what other people will think or say. You do have control over whom you are surrounded by, at least a lot of the time. If you have someone making comments you do not appreciate, you can always speak up. This can create an uncomfortable social situation. Another option is to avoid or distance yourself from them.

Clothing 

Since pregnancy is over nine months, most of the changes you experience are gradual. However, you will likely have some instances where it seems like your belly grew overnight. A big tip that will help your body image is to get maternity clothes. It can be very disheartening not to fit into anything in your closet. Even if you can squeeze into pre-pregnancy clothes, wearing uncomfortable clothing can be a constant reminder that your body is changing and getting bigger. It is not worth it to suffer in uncomfortable clothes. Wearing too tight or small clothing will not make you feel good physically or emotionally. There is a full episode on maternity clothes with tips for any budget and even some hacks to repurpose existing items in your closet.

Take Photos 

Some expecting mothers document every week of their pregnancy with photos to show off their bump. Others prefer not to get in front of a camera. Even if you are not excited about showing off your bump and changing body, I encourage you to take photos throughout your pregnancy journey. You can always keep them to yourself and not share them. This is a short phase in your life; you may look back and wish you had more pictures. Even if you have more kids, each pregnancy is different. Later on, maybe even many years down the road, you will wish you had more photos of yourself pregnant.

Positive Impacts on Your Body Image 

What if there were a pill you could take that would positively impact your body image, promote a healthy weight gain during pregnancy, help you sleep better, manage stress better, and even increase your mood? Plus, there are no adverse side effects. Would you take it? There is an intervention that fits this description; it is exercise. You do not have to join a cross-fit gym or buy a Peleton. You can start by walking or doing yoga in your living room.

There are endless ways to exercise safely in any stage of pregnancy, and the benefits are significant. Try different things and find out what works for you. Maybe after you have your baby, you want to join Stroller Strides, a workout you can do with your baby in a stroller. Perhaps you walk your baby in the stroller down the street to a park for fresh air. I know not everyone loves to work out, but you can get on board with some form of exercise. I don’t promote exercise as a weight-loss tool, although you can utilize it for that purpose. I encourage exercise for all of the positive effects it can have on your physical and mental health. 

Body Image in the Postpartum Period 

One thing that surprises some new moms is that they still look pregnant after they have their baby. While you lose a lot of weight at birth with your baby, the placenta amniotic fluid takes a long time to recover from pregnancy and birth. There is such a focus on getting back to your pre-pregnancy weight, and many new mothers struggle with changes to their bodies after having a baby.

Your focus after having a baby needs to be on your overall health and the health of your baby, which mainly includes eating well, sleeping when you can, and lots of snuggling with your new baby. As you are stepping into your new role as a mother or as a mother of multiple children, if this is not your first baby, this is a significant life change and one that is more difficult when you are preoccupied with your body. You are not the same person after having a baby as you were before. If it is important for you to return to your pre-pregnancy weight healthily, I applaud you. If this is not your priority, that’s okay too. You need to focus on caring for your health, yourself, and your baby. 

A review that included 19 studies looked at body image and how it affected postpartum depression. The majority of studies found that body image dissatisfaction is consistently but weakly associated with the onset of prenatal and postpartum depression. Some studies even looked at the reverse and found that depression contributed to negative body image. This makes sense, and it doesn’t take a medical degree to determine that negative feelings about your body don’t make you happier. 

Trans Pregnancy 

Body image can be stressful and challenging for someone who does not identify as a female but can and decides to get pregnant. Pregnancy is a possibility for someone who may have transitioned from female to male but has not had surgery to remove their reproductive organs. Someone who is trans may spend years taking hormones and living publicly as a male. Then you get pregnant, stop taking hormones, and you have much higher estrogen levels. All of these changes taking place may not be consistent with your identity. It may be helpful to seek out a doctor or midwife who has experience with trans pregnancy. Becoming pregnant comes with challenges for everyone. For someone who is trans, this may present additional challenges. Check out the Longest Shortest Time, Accidental Gay Parents Series for a great podcast on this topic. 

Evidence-based Techniques to Improve Body Image 

A study examined evidence-based techniques to improve body image, and the researchers classified interventions into four categories. The first is cognitive behavioral therapy , which aims to modify dysfunctional thoughts, feelings, and behaviors that contribute to negative body image. Fitness training, especially when there were perceived improvements in your body’s capabilities, like when you perceive yourself getting stronger due to working out. Media literacy breaks down the idea that images we see in the media as ideal are not realistic. Hypothetically, discrediting these images gives them less influence over our perception of body image. We improve self-esteem by identifying and appreciating individual differences in appearance, strengths, and talents.

Which change techniques were effective? Cognitive-behavioral therapy had positive effects on body image. Changing the language you use to describe your body was also effective. Not just what you say out loud but what you internally tell yourself about your body. Exercise was also found to be beneficial. 

What didn’t work was providing self-esteem enhancement exercises, discussing physical fitness, and discussing individual differences; each decreased the effectiveness of the interventions. Media literacy also did not improve body image. When looking at the interventions that do help, there is no magic pill to give you a positive body image, and although these things were positive, the change was small.

Body Dysmorphic Disorder 

I do want to cover some specific disorders associated with body image. Body dysmorphic disorder is a mental disorder in which you cannot stop thinking about perceived defects or flaws in your appearance, which others don’t even notice or are minor. To you, they’re not minor and can affect you so much that they cause anxiety and shame. These feelings can lead you to avoid social situations due to discomfort about your appearance. This can cause obsessive behavior that can impact your daily life.  

Eating Disorders 

Eating disorders are behaviors around eating that have a negative impact on your health. By health, I mean not just your physical health but your mental health as well. One study found 9.2% of women pre-pregnancy and 7.5% of pregnant women have an eating disorder. These percentages are for disorders that are clinically diagnosed. Many individuals may have an unhealthy relationship with food even though they may not be clinically diagnosed with an eating disorder. 

Anorexia, technically named anorexia nervosa, is when you have extremely low body weight and a distorted perception of your weight. People who are anorexic limit their weight by restricting food intake, excessive exercise, using substances like laxatives or diet aids, or vomiting after eating. Bulimia nervosa, or bulimia, is when you don’t have control over your eating, and you binge and purge. You may restrict eating all day, overeat, and then use unhealthy methods to get rid of those calories by vomiting, excess exercise, or laxatives. The big difference between bulimia and anorexia is that people who have bulimia are at normal weight or overweight. Binge-eating disorder is when you binge on foods. This differs from anorexia and bulimia because you do not try to purge or over-exercise to combat binge eating.

External influences on body image can push people to develop eating disorders. There may also be a genetic component predisposing some people to develop an eating disorder. Biological changes to the dopaminergic or serotonergic systems can also affect your behavior. These are the systems responsible for releasing dopamine and serotonin.

Diagnosing and Treating Eating Disorders

One big challenge in diagnosing and treating eating disorders is the negative stigma associated with mental health disorders. These are valid issues, and anyone suffering from these should not feel shame or embarrassment. The more we discuss issues like these, the less negative stigma we attach to them. 

One study looked at barriers to identifying eating disorders during pregnancy and postpartum and found the biggest problem is stigma. This negative stigma comes from shame, embarrassment, or fear of judgment. Someone with an eating disorder may be reluctant to disclose issues to a care provider or seek treatment. This is the case for 1 in 4 people who have an eating disorder during pregnancy. The next significant barrier is the poor education of care providers about eating disorders. Combine that with a very short window for an appointment, typically 15 minutes or less, and this topic doesn’t get attention.

Treatments for eating disorders include psychotherapy, nutritional and diet support, cognitive behavioral therapy, behavioral monitoring, and medications. 

Eating Disorders for Fertility and Pregnancy

Eating disorders can be associated with irregular menstruation, which isn’t ideal if you are trying to conceive. Overall, data doesn’t show that eating disorders have significantly higher infertility rates. You know that the best thing you can do for fertility is to be healthy, and an eating disorder does not positively contribute to that. 

There is mixed evidence on the impact of eating disorders on the mother during pregnancy and her baby. The Norweigan Mother and Child Cohort Study included over 35,000 participants over a long period. This study looked at the birth outcomes of women with eating disorders, among many topics. When examining anorexia, bulimia, and binge eating disorder, some effects were adverse birth outcomes, low-weight and over-weight babies, and premature labor. For mothers, they found sleeping issues, higher rates of morning sickness, excessive weight gain, stress about weight gain, breastfeeding difficulties, and slower growth rates in babies, which may be due to breastfeeding issues or shorter duration of breastfeeding.

There is some good news. Those who have an eating disorder before getting pregnant generally tend to improve during pregnancy. That doesn’t mean it is easy or they do not struggle. Unfortunately, pregnancy can cause past easing disorders to resurface, causing relapse. 

Talking to Your Doctor or Midwife 

If you have any questions about body image, eating disorders, or negative habits around eating, please bring them up with your doctor or midwife. If you have dealt with an eating disorder in the past or are currently struggling, please disclose it to your doctor or midwife. If you have any specific struggles, you may consider seeking a midwife or OBGYN who has experience with those issues. If you are struggling with any problem related to body image, you are not alone in this struggle. There are resources to help, and talking to your doctor or midwife is a great place to start. 

Closing Thoughts

Even if you are not anorexic or didn’t even know binge eating disorder was a thing before this episode, think about your body image and how that is changing during pregnancy. Think about the transformation you are going through and how your body is growing a healthy human. That is amazing and something to celebrate. 

Most importantly, if you are not thrilled with your body image pre-, during, or post-pregnancy, you are not alone. I wish we could all be happy and excited about the changes, pumped to take our weekly bump picture, proud to share our maternity photos, and happy to see our bodies at every stage of the baby-making process. It can be a struggle to appreciate what our bodies do, and how you feel is on the spectrum of normal.

Thank you to the amazing companies that have supported this episode.